Assessing 3D T2 FSE sequence for identification of the normal appendix: working toward a single-sequence MR...

Area of Science:

• Radiology
• Medical Imaging
• Pediatric Imaging

Background:

• Pediatric appendicitis diagnosis often relies on ultrasound.
• Alternative imaging modalities are needed when ultrasound is inconclusive.
• Magnetic Resonance Imaging (MRI) offers detailed anatomical visualization.

Purpose of the Study:

• To evaluate the efficacy of a single isotropic 3D T2 Fast Spin Echo (FSE) sequence in visualizing the normal appendix in children.
• To assess the potential of this sequence as a second-line diagnostic tool for pediatric appendicitis.

Main Methods:

• Retrospective review of 22 pediatric MRI scans (Oct 2014-Dec 2016) using a single 3D T2 FSE sequence.
• Exclusion criteria included prior appendectomy, incomplete field of view, and fat-saturated acquisition.
• Three radiologists blindly assessed appendix visualization, demonstrability, location, and signs of appendicitis.

Main Results:

• The appendix was visualized in 72.7-81.8% of cases with good inter-rater agreement (Fleiss Kappa 0.52-0.76).
• High confidence visualization was achieved in 54.5% of cases.
• The appendix was most commonly located in the deep pelvis; no findings indicated appendicitis.

Conclusions:

• A single 3D T2 FSE sequence demonstrates good capability for detecting normal appendices in children.
• Multiplanar reconstructions are possible, supporting its use as a single-sequence protocol.
• This technique may serve as a valuable alternative when ultrasound is inconclusive for pediatric appendicitis.